Orthopaedic review最新文献

Scoliosis is the most common orthopaedic problem encountered in Rett syndrome. It is characterized by a long C-shaped thoracolumbar curve of neurologic origin. The occurrence of scoliosis in Rett syndrome is age-dependent, with a reported incidence of 36% to 100%. The onset of scoliosis is usually before age 8 years, and rapid curve progression is usually detected early in the second decade. In Rett syndrome, sagittal deformity with excessive kyphosis can progress and necessitates close observation. Orthotic treatment does not alter the natural history of scoliosis or kyphosis. Indications for surgery are curve progression exceeding a 40 degree or 45 degree Cobb angle or curves that cause pain or loss of function. Anterior discectomy, interbody fusion, and posterior fusion with instrumentation can achieve improved correction in young adolescents with significant curves. Surgical intervention should include fusing the scoliotic and the excessively kyphotic segments.

To test the diagnostic value of T1 spin-echo and T1 fat-saturated magnetic resonance images (MRIs), we reviewed axial T1-weighted images with and without fat saturation in 20 patients with clinically suspected chondromalacia of the patella. All scans were obtained on 1.5-MR units. The scans were randomly ordered and reviewed independently at different times by two radiologists without knowledge of the arthroscopy results. The sensitivity of the individual techniques for detecting grade 3 or 4 chondromalacia patellae was 92% for fat-saturated axial T1-weighted images alone, and 67% for axial T1-weighted images without fat saturation. The sensitivity of the combined techniques was 100% for grades 3 and 4 and 90% for all grades (0 to 4). Chondromalacia patellae is diagnosed more accurately by using T1 fat saturation than by using T1 spin-echo images. With a combination of the two techniques, accuracy is 90% to 100%.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. The initial history, physical findings, and roentgenographic examinations are found on this page. The clinical and roentgenographic diagnoses are presented on the following pages.

Tumors at the spinal cord level present challenging surgical problems. Hypernephromas and other tumors may have copious bleeding at the time of resection. This bleeding can be reduced by preoperative embolization resulting in a dramatic decrease in surgical morbidity. However, embolization does carry a risk of spinal cord infarction and resultant neurologic injury. To monitor this, somatosensory evoked potentials (SSEPs) were evaluated during embolization, with a resultant termination of the procedure after significant SSEP changes and clinical symptoms indicated cord ischemia. The SSEP readings normalized 24 hours later, by the time of surgical resection. We present a relevant case history and review of the literature on this subject. Clearly, SSEPs, and in the future, motor evoked potentials (MEPs), serve as a valuable adjunct to monitoring spinal cord function during embolization and may prevent preoperative ischemic injury.

The open reduction and internal fixation of complex acetabular fractures generally require some amount of sustained intraoperative traction. This traction can be provided by either specialized traction tables or scrubbed assistants. Both methods have their advantages and disadvantages. Specialized traction tables provide excellent controlled traction but are costly. Interested assistants are less costly, but at many institutions an adequate number of them are unavailable. We describe the design, construction, and use of a simple intraoperative traction device to aid in the open reduction and internal fixation of acetabular fractures.

Volar rotatory dislocation of the proximal interphalangeal (PIP) joint often cannot be reduced by closed manipulation because of interposition of soft tissues. In this case, the condyle of the proximal phalanx was trapped between the central slip and the lateral band. This case is reported to reemphasize the importance of recognizing serious injuries involving the soft tissues around the PIP joint. Deprival of its normal dorsal stabilizing forces can cause a loss of both static and dynamic joint support. Secondary scarring and contractures affect all damaged structures of the joint.